Anxiety and Depression Disorder

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Oleh: KuntjojoA. Pengertian Neurosis

Neurosis kadang-kadang disebut psikoneurosis dangangguan jiwa (untuk membedakannya dengan psikosis ataupenyakit jiwa. Menurut inggih !irgagunarsa ("#$% : "&')neurosis adalah gangguan yang terjadi hanya pada sebagiandari kepribadian) sehingga orang yang mengalaminya masihbisa melakukan pekerjaan-pekerjaan biasa sehari-hari ataumasih bisa belajar) dan jarang memerlukan perawatan khususdi rumah sakit.

!ali *ulo ("#%+ : "$#) berpendapat bahwa neurosis adalahsuatu kelainan mental) hanya memberi pengaruh padasebagaian kepribadian) lebih ringan dari psikosis) dan seringkaliditandai dengan : keadaan ,emas yang kronis) gangguan-gangguan pada indera dan motorik) hambatan emosi) kurangperhatian terhadap lingkungan) dan kurang memiliki energiisik) dst.

Nurosis) menurut ./. Maramis ("#%0 : #$) adalah suatukesalahan penyesuaian diri se,ara emosional karena tidakdiselesaikan suatu konlik tidak sadar.

1erdasarkan pendapat mengenai neurosis dari para ahlitersebut dapat diidentiikasi pokok-pokok pengertian mengenaineurosis sebagai berikut:

a. Neurosis merupakan gangguan jiwa pada tara ringan.b. Neurosis terjadi pada sebagian ke,il aspek kepribadian.

,. Neurosis dapat dikenali berdasarkan gejala yang palingmenonjol yaitu ke,emasan.

d. Penderita neurosis masih mampu menyesuaikan diri danmampu melakukan akti2itas sehari-hari.

e. Penderita neurosis tidak memerlukan perawatan khususdi rumah sakit jiwa.

1. Ma,am-ma,am neurosisKelainan jiwa yang disebut neurosis ditandai dengan

berma,am-ma,am gejala. !an berdasarkan gejala yang palingmenonjol) sebutan atau nama untuk jenis neurosis diberikan.

!engan demikian pada setiap jenis neurosis terdapat ,iri-,iridari jenis neurosis yang lain) bahkan kadang-kadang ada pasienyang menunjukkan begitu banyak gejala sehingga gangguan

jiwa yang dideritanya sukar untuk dimasukkan pada jenisneurosis tertentu (./. Maramis) "#%0 : +3%.1ahwa nama atau sebutan untuk neurosis diberikanberdasarkan gejala yang paling menjonjol atau paling kuat. Atas


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dasar kriteria ini para ahli mengemukakan jenis-jenis neurosissebagai berikut (./. Maramis) "#%0 : +3$-+3%.

". Neurosis cemas(an4iety neurosis atau an4iety statea. *ejala-gejala neurosis ,emas

5idak ada rangsang yang spesiik yang menyebabkan

ke,emasan) tetapi bersiat mengambang bebas) apasaja dapat menyebabkan gejala tersebut. 1ilake,amasan yang dialami sangat hebat maka terjadikepanikan." *ejala somatis dapat berupa sesak naas) dada

tertekan) kepala ringan seperti mengambang) lekaslelah) keringat dingan) dst.

+ *ejala psikologis berupa ke,emasan) ketegangan)panik) depresi) perasaan tidak mampu) dst.

b. /aktor penyeban neurosis ,emas

Menurut Maramis ("##% : +6") aktor pen,etusneurosis ,emas sering jelas dan se,ara psikodinamikberhubungan dengan aktor-aktor yang menahunseperti kemarahan yang dipendam.

,. 5erapi untuk penderita neurosis ,emas5erapi untuk penederita neurosis ,emas dilakukandengan menemukan sumber ketakutan ataukekuatiran dan men,ari penyesuaian yang lebih baikterhadap permasalahan. Mudah tidaknya upaya inipada umumnya dipengaruhi oleh kepribadian

penderita. Ada beberapa jenis terapi yang dapat dipilihuntuk menyembuhkan neurosis ,emas) yaitu : "psikoterapi indi2idual) + psikoterapi kelompok) 'psikoterapi analitik) & sosioterapi) 3 terapi senikreati) 6 terapi kerja) $ terapi perilaku) dan %armakoterapi.

+. Histeriaa. *ejala-gejala histeria

7isteria merupakan neurosis yang ditandai denganreaksi-reaksi emosional yang tidak terkendali sebagai

,ara untuk mempertahankan diri dari kepekaannyaterhadap rangsang-rangsang emosional. Pada neurosis

jenis ini ungsi mental dan jasmaniah dapat hilangtanpa dikehendaki oleh penderita. *ejala-gejala seringtimbul dan hilang se,ara tiba-tiba) teruma bilapenderita menghadapi situasi yang menimbulkanreaksi emosional yang hebat.


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b. 8enis-jenis histeria7isteria digolongkan menjadi +) yaitu reaksi kon2ersiatau histeria minor dan reaksi disosiasi atau histeriamayor." Histeria minor atau reaksi konversi

Pada histeria minor ke,emasan diubah ataudikon2ersikan (sehingga disebut reaksi kon2ersimenjadi gangguan ungsional susunan sarasomatomotorik atau somatosensorik) dengan gejala: lumpuh) kejang-kejang) mati raba) buta) tuli) dst.

+ 7isteria mayor atau reaksi disosiasi7isteria jenis ini dapat terjadi bila ke,emasan yangyang alami penderita demikian hebat) sehinggadapat memisahkan beberapa ungsi kepribadiansatu dengan lainnya sehingga bagian yang terpisah

tersebut berungsi se,ara otonom) sehingga timbulgejala-gejala : amnesia) somnabulisme) ugue) dankepribadian ganda.

,. /aktor penyebab histeriaMenurut igmund /reud) histeria terjadi karenapengalaman traumatis (pengalaman menyakitkanyang kemudian direpresi atau ditekan ke dalam alamtidak sadar. Maksudnya adalah untuk melupakan ataumenghilangkan pengalaman tersebut. Namunpengalaman traumatis tersebut tidak dapat

dihilangkan begitu saja) melainkan ada dalam alamtidak sadar (un,o,iousness dan suatu saat mun,ulkedalam sadar tetapi dalam bentuk gannguan jiwa.

d. 5erapi terhadap penderita histeriaAda beberapa teknik terapi yang dapat dilakukanuntuk menyembuhkan hysteria yaitu :" 5eknik hipnosis (pernah diterapkan oleh dr. 8oseph

1reuer9+ 5eknik asosiasi bebas (dikembangkan oleh igmund

/reud9

' Psikoterapi suporti.& /armakoterapi.

'. Neurosis fobika. Gejala-gejala neurosis fobik

Neurosis obik merupakan gangguang jiwa dengangejala utamanya obia) yaitu rasa takut yang hebatyang bersiat irasional) terhadap suatu benda atau


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keadaan. /obia dapat menyebabkan timbulnyaperasaan seperti akan pingsan) rasa lelah) mual) panik)berkeringat) dst.Ada berma,am-ma,am obia yang nama atausebutannya menurut aktor yang menyebabkan

ketakutan tersebut) misalnya :" Hematophobia: takut melihat darah+ Hydrophobia: takut pada air' Pyrophibia: takut pada api&Acrophobia: takut berada di tempat yang tinggi

b. Faktor penyebab neurosis fobikNeurosis obik terjadi karena penderita pernahmengalami ketakutan dan sho,k hebat berkenaandengan situasi atau benda tertentu) yang disertaiperasaan malu dan bersalah. Pengalaman traumastis

ini kemudian direpresi (ditekan ke dalam ketidaksadarannya. Namun pengalaman tersebut tidak bisahilang dan akan mun,ul bila ada rangsangan serupa.

c. erapi untuk penderita neurosis fobikMenurut Maramis) neurosa obik sulit untuk dihilangkan sama

sekali bila gangguan tersebut telah lama diderita atauberdasarkan obi pada masa kanak-kanak. Namun bilagangguan tersebut relati baru dialami prosespenyembuhannya lebih mudah. 5eknik terapi yangdapat dilakukan untuk penderita neurosis obik

adalah :" Psikoterapi suporti) upaya untuk mengajar

penderita memahami apa yang sebenarnya diaalami beserta psikodinamikanya.

+ 5erapi perilaku dengandeconditioning) yaitu setiapkali penderita merasa takut dia diberi rangsangyang tidak menyenagkan.

' 5erapi kelompok.& Manipulasi lingkungan.

&. Neurosis obsesif-kompulsif

a. Gejala-gejala neurosis obsesif-kompulsifstilah obsesi menunjuk pada suatu ide yang mendesakke dalam pikiran atau menguasai kesadaran dan istilahkompulsi menunjuk pada dorongan atau impuls yangtidak dapat ditahan untuk tidak dilakukan) meskipunsebenarnya perbuatan tersebut tidak perlu dilakukan.;ontoh obsesi-kompulsi antara lain 9


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1urns berpendapat bahwa persepsi indi2idu terhadaprealitas tidak selalu bersiat objekti. ndi2idumemahami realitas bukan bagaimana sebenarnyarealitas tersebut) melainkan bagaimana realitastersebut ditasirkan. !an penasiran ini bisa keliru

bahkan bertentangan dengan realitas sebenarnya.d. erapi untuk penderita neurosis depresif

?ntukmenyembukan depresi) 1urns ("#%% : 3 telahmengembang-kan teknik terapi dengan prinsip yangdisebut terapi kognitif) yang dilakukan dengan prinsipsebagai berikut." 1ahwa semua rasa murung disebabkan oleh

kesadaran atau pemikiran ang bersangkutan.+ 8ika depresi sedang terjadi maka berarti pemikiran

telah dikuasai oleh kekeliruan yang mendalam.

' 1ahwa pemikiran negati2e menyebabkan keka,auanemosional.

5erapi kogniti dilakukan dengan ,ara membetulkanpikiran yang salah) yang telah menyebabkanterjadinya keka,auan emosional. elain terapi kogniti)bisa pula pendrita depresimendapatkan farmakoterapi.

6. Neurastheniaa. Gejala-gejala neurasthenia

Neurasthenia disebutjuga penyakit payah. *ejala

utama gangguan ini adalah tidak bersemangat) ,epatlelah meskipun hanya mengeluarkan tenaga yangsedikit) emosi labil) dan kemampuan berpikir menurun.!i samping gejala-gejala utama tersebut juga terdapatgejala-gejala tambahan) yaitu insomnia) kepala pusing)sering merasa dihinggapi berma,am-ma,am penyakit)dst.

b. Faktor penyebab neurastheniaNeurasthenia dapat terjadi karena beberapa aktor(@akiah !aradjat) "#%' : '&) yaitu sebagai berikut.

" 5erlalu lama menekan perasaan) pertentanganbatin) ke,emasan.

+ 5erhalanginya keinginan-keinginan.' ering gagal dalam menghadapi persaingan-

persainganc. erapi untuk penderita neurasthenia


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?paya membantu penyembuahn penderitaneurasthenia dapat dilakukan dengan teknik terapisebagai berikut." Psikoterapi supporti9+ 5erapi olah raga9

' /armakoterapi.eerensi

1ran,a) Albert A. ("#63 Psychology $ he %cience of

&ehavior. 1oston : Allyn and 1a,on) in,.

1urns) !a2id !. ("##% erapi !ognitif $ Pendekatan &aru &agi

Penanganan 'epresi. (Alih 1ahasa : antosa 8akarta :

Brlangga.

!irgagunarsa) inggih. ("#%% Pengantar

Psikologi. 8akarta : 1PK *unung Mulia.

Maramis) ./. ("#%0 (lmu !edokteran )i*a. urabaya :

Airlangga ?ni2ersity.

;ontoh diagnosa keperawatan

". Ketidak eektian koping indi2idu

Kemungkinan penyebab :

". Krisis situasional atau krisis maturasional

+. iwayat konlik keluarga dan system pendukung yang tidak adekuat

'. tress internal yang berat dari banyak perubahan kehidupan

&. Kerentanan herediter

3. iwayat prolaps pada katup mitral atau tirotoksikosis

1atasan karakteristik :

". *ejala isik yang dialami selama serangan

+. Perlaku menghindar

'. 5idak mampu menyelesaikan masalah

&. Menggunakan Cat psikoakti untuk bersosialisasi atau untuk menoleransi

ketakutan dari serangan panik

3. Menyatakan se,ara 2erbal ketakutannya yang besar akan serangan lainnya.


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5ujuan jangka panjang :

Klien menunjukkan kemampuan untuk mengatasi panik dengan mengurangi

perilaku yang disebabkan oleh keadaan panik.

5ujuan jangka pendek "

Klien ber,erita tentang stressor kehidupan) terutama yang berhubungan dengan

serangan pani, dimasa lalu.

nter2ensi dan rasional

". !orong klien untuk mengungkapkan se,ara 2erbal perasaan yang begitu kuat)

tidak nyaman) khususnya ansietas) rasa bersalah dan rustasi.

asional :

Perasaan sakit yang tidak diakui adalah stressor) mengungkapkan perasan yang

tidak nyaman membantu meredakan stress.

+. 1antu klien mengidentiikasi stressor internal yang umumnya terjadi sebelum

serangan.

asional :

ebelum klien dapat memperoleh kendali terhadap serangan) stressor yang

berhubungan dengan pani, harus diidentiikasi.

'. !iskusikan dan analisa situasi pani, dengan klien) berokus pada stimulus

eksternal yang merangsang serangan.

asional :

Analisa stimulus eksternal yang menyertai pani, membantu klien mengantisipasi

dan pada akhirnya mengontrol serangan.

&. !iskusikan mekanisme koping) seperti gerakan isik dan latihan napas dalam

yang lambat dan bagaimana mekansme ini dapat panik.

asional :

Klien perlu mengetahui metode koping lain yang dapat digunakan untuk mengatasi

ansietas yang tidak dapat ditoleransi akibat serangan panik.


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5ujuan jangka pendek +

Klien menunjukkan perilaku yang membantu mengontrol keadaan pani,.


". Ajari klien strategi untuk mengatasi stressor internal) seperti ketakutan atauperasaan tidak menentu.

asional :

Memiliki pengetahuan tentang ,ara alternati2e untuk menangani stress akan

meningkatkan kendali perilaku.

+. Ajari klien tentang ,ara berpindah dari keadaan internal ke keadaan eksternal

untuk mengalihkan perhatian klien dari dirinya sendiri.

asional :

Keterampilan ini memampukan klien untuk melepaskan ansietas melalui o,us

keluar.

'. !iskusikan hubungan antara ansietas dengan respons isiologis yang se,ara

khas di tunjukkan dalam serangan pani,

asional :

5indakan ini memasilitasi daya tolak klien kedalam hubungan antara ansietas dan

gejala isik akibat serangan pani,.

&. 1antu klien memodiikasi pikiran spontan yang enyertai gejala isik ketika

ansietas mulai timbul.

asional :

Klien perlu mengetahui bahwa gejala isiologis ansietas diikuti oleh pikiran spontan

yang mengganggu penilaian tentang apa yang sedang terjadi.

3. !orong klien membentuk system pendukung dan men,ari bantuan ketika

tanda dan gejala ansietas mun,ul.

asional :

Mengembangkan dan menggunakan system pendukung meningkatkan tanggung

jawab pribadi dan pengakuan pribadi tentang kebutuhan memperoleh bantuan

pada saat stress.

+. Ketakutan

Kemungkinan penyebab :


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". Konlik emosional yang tidak disadari

+. alah menempatkan ansietas

'. Pengalaman hidup di masa lalu

&. Kurang engetahuan

3. Kesalahan persepsi sensori

1atasan karakeristik :

". Maniestasi isik dan emosi yang disebabkan oleh ansietas berat

+. Mengungkapkan rasa tidak nyaman terhadap objek atau situasi yang

menakutkan

'. 5idak mampu melaksanakan akti2itas hidup sehari-hari

&. Menarik diri dari akti2itas yang biasa ketika rasa takutnya berlebihan

3. erangan panik.

5ujuan angka panjang :

Klien mempelajari ,ara untuk tetap berungsi dengan baik ketika menghadapi

stimulus obia tanpa mengalami ansietas hebat atau membuat ia tidak mampu.

5ujuan jangka pendek "

Klien megungkapkan rasa takut dan mengidentiikasi ansietas yang timbul akibatobia.

nter2ensi dan rasonal

". !orong klien untuk mendiskusikan obek atau situasi yang menakutkan.

asional :

!skusi tentang bagaimana klien mempersepsikan obia memberi dasar untuk

membuat program terapi.

+. 1ersama klien berupaya mengidentiikasi konlik dasar yang menimbulkanobia.

asional :

!engan megidentiikasi konlik dasar dan ansietas yang ditimbulkan) klien dapat

menghubungkan pengalaman ansietas dalam diri dengan obianya.


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'. 1antu klien mengidentiikasikan dan mendiskusikan pikiran dan perasaan

yang turut menimbulkan rasa takut.

asional :

Pengungkapan pikiran dan perasaan memungkinkan klien untuk menggali isu-isu

yang mungkin ditekan (se,ara sadar mematikan kesadarannya atau belum

terselesaikan.

&. dentiikasi apakah klien mengalami depresi dan atasi

asional :

Klien depresi sulit berkonsentrasi dan tidak mampu berokus pada strategi untuk

mengatasi respon obia.

3. Ajari klien bahwa obia adalah sebuah gambaran simbolik dari ansietas.

asional :

Kesadaran bahwa obia timbul dari ke,emasan membantu klien untuk tidak

berhubungan dengan respon obik dan memokuskan perhatian pada masalah yang

menyebabkan ansieas.

5ujuan jangka pendek +

Klien berpartisipasi dalam program densitiasi ( pengurangan sensiti2itas dan

memperagakan ,ara-,ara koping untuk mengatasi obia.


". ebelum program desentitisasi dimulai) yakinkan klien bahwa keamanannya

terjamin

asional :

Klien perlu merasa terlindungi dan aman untuk meneruskan program.

+. !iskusikan obia se,ara mendetil) ajarkan keterampilan koping seperti aserti

tekhnik berhenti berikir dan teknik menyelesaikan masalah

asional :

!apat mebentuk koping eekti

'. Minta klien mempelajari dan mempraktekkan latihan relaksasi dan

imajinasikan terpimpin.


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asional :

trategi ini membantu mengurangi tingkat ansietas klien.

&. 1ersama klien) esplorasi pikiran) perasaan atau peristiwa yang dapat

men,etuskan respons obik.

asional :

Kesadaran akan apa yang men,etuskan reaksi obik dapat memampukan klien

untuk mempelajari ,ara alternati2e untuk menangani ansietas.

Neurosis adalah gangguan emosional relatif ringan (seperti depresiringan dan fobia).

A term generally used to describe a nonpsychotic mental illness that triggersfeelings of distress and anxiety and impairs functioning.

Origins

The word neurosis means "nerve disorder," and was first coined in the lateeighteenth century by William Cullen, a Scottish physician. Cullens concept ofneurosis encompassed those nervous disorders and symptoms that do nothave a clear organic cause. Sigmund Freudlater used the term anxietyneurosisto describemental illnessor distress with extreme anxiety as a

defining feature.

There is a difference of opinion over the clinical use of the term neurosistoday. !t is not generally used as a diagnostic category by Americanpsychologists and psychiatrists any longer, and was removed from the

American

The features of a typical neuron.(Hans & Cassidy. Gale Group. Reproduced withpermission.)

sychiatric AssociationsDiagnostic and Statistical Manual of MentalDisordersin #$%& with the publication of the third edition 'it last appeared asa diagnostic category inDSM-II(. Some professionals use the term to describeanxious symptoms and associated behavior, or to describe the range of mentalillnesses outside of the psychotic disorders'e.g.,schizophrenia,delusional disorder(. )thers, particularly psychoanalysts 'psychiatrists whofollow a psychoanalytical model of treatment, as populari*ed by +reudand Carl Jung(, use the term to describe the internal process itself 'called
http://kamuskesehatan.com/arti/depresi/http://kamuskesehatan.com/arti/fobia/http://psychology.jrank.org/pages/259/Sigmund-Freud.htmlhttp://psychology.jrank.org/pages/412/Mental-Illness.htmlhttp://psychology.jrank.org/pages/520/Psychotic-Disorders.htmlhttp://psychology.jrank.org/pages/556/Schizophrenia.htmlhttp://psychology.jrank.org/pages/556/Schizophrenia.htmlhttp://psychology.jrank.org/pages/352/Carl-Jung.htmlhttp://kamuskesehatan.com/arti/depresi/http://kamuskesehatan.com/arti/fobia/http://psychology.jrank.org/pages/259/Sigmund-Freud.htmlhttp://psychology.jrank.org/pages/412/Mental-Illness.htmlhttp://psychology.jrank.org/pages/520/Psychotic-Disorders.htmlhttp://psychology.jrank.org/pages/556/Schizophrenia.htmlhttp://psychology.jrank.org/pages/352/Carl-Jung.html


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space 'the gap between nervecells( to stimulate nerve cells, also assists thecell in reabsorbing the serotonin 'a process /nown as "reupta/e"(.

!n the case of the "neurosis gene," one possible version of its correspondingalleles 'called sfor their short length( was found to produce an insufficient

amount of this transporter protein, and the other 'named lfor long(, asignificantly large amount. !f the amount of transporter protein produced isinade2uate, an excessive amount of serotonin must remain in the synaptic gap

while the protein "catches up" with reupta/e, and the serotonin will continueto stimulate surrounding nerve cells, resulting in neurosis or neuroticsymptoms. A corresponding study of 3&& patients showed that patients who

were assessed as having neuroticpersonalitytraits usually possessed theshorter allele pair 'or a combination of one short and one long( that producedinsufficient transporter protein.

This finding is consistent with a study published the same year that found thatwomen in 45 different countries scored consistently higher on measurementsof neuroticism than men. The fact that such high scores were found across a

variety of socioeconomic classes and cultures but specific to one gender seemsto support a genetic basis for the disorder. 6owever, a #$$% study of over$,3&& 7nited 8ingdom residents found that those with a lower standard ofliving had a higher prevalence of neurotic disorders. !t is possible that geneticfactors predispose an individual to anxiety and neurosis, and outside factorssuch as socioeconomic status trigger the symptoms.

Diagnosis

atients with symptoms of mental illness should undergo a thorough physicalexamination and detailed patient history to rule out organic causes 'suchasbraintumor or head inury(. !f a neurotic disorder is suspected, apsychologist or psychiatrist will usually conduct an interview with the patientand administer clinical assessments 'also called scales, inventories, or tests(,to evaluate mental status. Tests which may be administered for the diagnosisand assessment of neurosis include the 0euroticism 9xtraversion and)penness '09):;( scale, the Sixteen ersonality +actor


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are causing the patient. odes of treatment are similar to that of other mentaldisorders, and can include psychotherapy, cognitive:behavioral therapy,creative therapies 'e.g., art or music therapy(,psychoactive drugs, andrelaxation exercises.

aula +ord:artin

Further Reading

+enichel, )tto . %e "sycoanalytic %eory of &eurosis' )t Anniversary*dition.0ew =or/- W.W. 0orton > Son. #$$3.

American sychiatric Association.Diagnostic and Statistical Manual ofMental Disorders?th ed. Washington, @C- American sychiatric ress, !nc.,#$$?.

Further Information

Anxiety @isorders Association of America 'A@AA(. ##$&& ar/lawn @rive,Suite #&&, ;oc/ville, @, 7SA. &%3, fax- 4:4#:54$, 4:4#:$43&.9mail- [email protected]. http-www.adaa.org.

;ead more-0eurosis : )rigins, Categories, Causes, @iagnosis, Treatment :ersonality !nventories, Theory )f ersonality, and ental : D;an/

Articleshttp-psychology.ran/.orgpages?3&0eurosis.htmlEix**aw#s

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http://psychology.jrank.org/pages/519/Psychotherapy.htmlhttp://psychology.jrank.org/pages/435/Music-Therapy.htmlhttp://psychology.jrank.org/pages/509/Psychoactive-Drugs.htmlhttp://psychology.jrank.org/pages/509/Psychoactive-Drugs.htmlhttp://www.adaa.org/http://psychology.jrank.org/pages/450/Neurosis.html#ixzz2jaw1sjPGhttp://psychology.jrank.org/pages/450/Neurosis.html#ixzz2jaw1sjPGhttp://psychology.jrank.org/pages/450/Neurosis.html#ixzz2jaw1sjPGhttp://psychology.jrank.org/pages/450/Neurosis.html#ixzz2jaw1sjPGhttp://psychology.jrank.org/pages/450/Neurosis.html#ixzz2jaw1sjPGhttp://psychology.jrank.org/pages/519/Psychotherapy.htmlhttp://psychology.jrank.org/pages/435/Music-Therapy.htmlhttp://psychology.jrank.org/pages/509/Psychoactive-Drugs.htmlhttp://www.adaa.org/http://psychology.jrank.org/pages/450/Neurosis.html#ixzz2jaw1sjPGhttp://psychology.jrank.org/pages/450/Neurosis.html#ixzz2jaw1sjPGhttp://psychology.jrank.org/pages/450/Neurosis.html#ixzz2jaw1sjPGhttp://psychology.jrank.org/pages/450/Neurosis.html#ixzz2jaw1sjPGhttp://psychology.jrank.org/pages/450/Neurosis.html#ixzz2jaw1sjPG


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GeneralizedAnxiety Disorder (GAD)*eneraliCed an4iety disorder is ,hara,teriCed by persistent) e4,essi2e) and unrealisti, worry about

e2eryday things.

People with the disorder) whi,h is also reerred to as *A!) e4perien,e e4aggerated worry and tension)

oten e4pe,ting the worst) e2en when there is no apparent reason or ,on,ern. 5hey anti,ipate disaster

and are o2erly ,on,erned about money) health) amily) work) or other issues. *A! is diagnosed when a

person worries e4,essi2ely about a 2ariety o e2eryday problems or at least 6 months. Dearn moresymptoms.

ometimes just the thought o getting through the day produ,es an4iety. 5hey don>t know how to stop

the worry ,y,le and eel it is beyond their ,ontrol) e2en though they usually realiCe that their an4iety is

more intense than the situation warrants.

*A! ae,ts 6.% million adults) or '."E o the ?.. population) in any gi2en year. omen are twi,e as

likely to be ae,ted.

5he disorder ,omes on gradually and ,an begin a,ross the lie ,y,le) though the risk is highest

between ,hildhood and middle age. Although the e4a,t ,ause o *A! is unknown) there is e2iden,e

that biologi,al a,tors) amily ba,kground) and lie e4perien,es) parti,ularly stressul ones) play a role.

hen their an4iety le2el is mild) people with *A! ,an un,tion so,ially and be gainully employed.Although they may a2oid some situations be,ause they ha2e the disorder) some people ,an ha2e

dii,ulty ,arrying out the simplest daily a,ti2ities when their an4iety is se2ere.

SymptomsPeople with generaliCed an4iety disorder (*A! e4perien,e ,onstant) ,hroni,) and unsubstantiated

worry) oten about health) amily) money) or work. 5his worrying goes on e2ery day) possibly all day. t

disrupts so,ial a,ti2ities and intereres with work) s,hool) or amily.

Physi,al symptoms o *A! in,lude the ollowing:

mus,le tension

atigue

restlessness

dii,ulty sleeping

irritability

edginess

gastrointestinal dis,omort or diarrhea

Treatment
http://www.adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad/symptomshttp://www.adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad/symptomshttp://www.adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad/symptomshttp://www.adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad/symptoms


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Dike other an4iety disorders) *A! is treatable. ;ogniti2e-beha2ioral therapy is ee,ti2e or many

people) helping them to identiy) understand) and modiy aulty thinking and beha2ior patterns. 5his

enables people with *A! learn to ,ontrol their worry. ome people with *A! also take medi,ation.

ela4ation te,hniFues) meditation) yoga) e4er,ise) and other alternati2e treatments may also be,ome

part o a treatment plan.

Other an4iety disorders) depression) or substan,e abuse oten a,,ompany *A!) whi,h rarely o,,urs

alone9 ,o-o,,urring ,onditions must also be treated with appropriate therapies.

Generalized Anxiety Disorder vs. General

Anxiety About the EconomyDooking o2er today>s dismal e,onomi, horiCon) you might eel as i there>s no end in sight. hether

you>re wat,hing your retirement sa2ings shrink) retting about how to pay or ,ollege) or worrying

about a possible layoGor e2en i you>re happily employed but ner2ously ollowing the news) these

are an4iety-pro2oking times.

Anxiety: A Normal Reactionorries about inan,es ha2e long been a leading ,ause o an4iety or Ameri,ans. hen asked whatstressed people the most in a re,ent A!AA online poll) &3 per,ent responded =personal inan,es.H

5hey ha2e good reason to eel stress. 5he ?.. !epartment o Dabor reported in Mar,h +00# that the

number o people re,ei2ing unemployment beneits rea,hed a re,ord high.

5he ollowing month a ashington Post-A1; News poll reported that more than si4 in "0 Ameri,ans

say they are stressed out o2er the nation>s troubled e,onomy) one-third reporting serious stress. B2en

among those who eel the e,onomy is impro2ing) a majority still named it as a sour,e o their stress.

Another A!AA online poll ,onirms that sentiment: Nearly $$ per,ent said the e,onomi, downturn has

,aused a moderate amount to =a lot o stress.H

so many people share su,h deep stress and worry about their bank balan,es than they did beore

this inan,ial ree all) does that mean they all ha2e an an4iety disorderI !oes it mean an4iety

disorders are on the riseI 5he answer: no.

An4iety is a normal rea,tion to stressul and un,ertain situations. t>s your body telling you to stay alert

and prote,t yoursel) in this ,ase to wat,h your spending) try to sa2e or an emergen,y) work to keep

your job) or ,onsult a trusted inan,ial e4pert.

Diagnosis: Generalized Anxiety Disorder7owe2er) you may ha2e generaliCed an4iety disorder i you worry about the e,onomy or your inan,es

or many hours e2ery day) you ,an>t sleep or perorm your usual tasks) and you>re aware that your

ears are irrational.

Also known as *A!) this type o an4iety disorder diers greatly rom the normal an4iety we may eel

about the e,onomy or any other stressul e2ent. *A! is not triggered by a spe,ii, situation. 5he world

doesn>t need to e4perien,e an e,onomi, downall or someone to ha2e *A!.

B2en in the best o times) *A! ae,ts 6.% million adults) or '."E o the ?.. population) in any gi2en

year) and women are twi,e as likely to be ae,ted.

People with generaliCed an4iety disorder e4perien,e persistent) e4,essi2e) and unrealisti, worry about

issues like money) health) amily) or work or si4 months or longer. 5hey don>t know how to stop the


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worry ,y,le) whi,h they eel is beyond their ,ontrol.Dearn more symptoms.

1e,ause the disorder reFuently ,o-o,,urs with other an4iety disorders) depression) or a sleep

disorder) it>s wise to raise ,on,erns with your do,tor about other symptoms.

Good News: GAD Is TreatableDike other an4iety disorders) *A! ,an be ee,ti2ely treated with psy,hotherapy) medi,ation) or a

,ombination. ;ogniti2e-beha2ioral therapy) or ;15) tea,hes skills or handling an4iety) whi,h helpsthose with *A! learn to ,ontrol their worry on their own. Dearn more about ;15.

ome people ind that medi,ationis helpul9 the ?.. /ood and !rug Administration has appro2ed

se2eral antidepressants or the treatment o *A!. s one number that hasn>t ,hanged

re,ently. 1ut an4iety disorders are real) serious) and treatable) and like many people who ha2e

o2er,ome them) you ,an) too.

Obsessive-CompulsiveDisorder (OCD);hildren and adults with obsessi2e-,ompulsi2e disorder (O;! suer rom unwanted and intrusi2e

thoughts that they ,anJt seem to get out o their heads (obsessions) oten ,ompelling them to

repeatedly perorm ritualisti, beha2iors and routines (,ompulsions to try and ease their an4iety.

Most people who ha2e O;! are aware that their obsessions and ,ompulsions are irrational) yet they

eel powerless to stop them.

ome spend hours at a time perorming ,ompli,ated rituals in2ol2ing hand-washing) ,ounting) or

,he,king to ward o persistent) unwel,ome thoughts) eelings) or images.Dearn more symptoms.

5hese ,an interere with a personJs normal routine) s,hoolwork) job) amily) or so,ial a,ti2ities. e2eral

hours e2ery day may be spent o,using on obsessi2e thoughts and perorming seemingly senseless

rituals. 5rying to ,on,entrate on daily a,ti2ities may be dii,ult.

Det untreated) O;! ,an interere with all aspe,ts o lie.

;hildren suer rom O;!. ?nlike adults) howe2er) ,hildren with O;! may not realiCe that their

obsessions and ,ompulsions are e4,essi2e.

SymptomsObsessions unwanted intrusive thoughts ;onstant) irrational worry about dirt) germs) or ,ontamination.

B4,essi2e ,on,ern with order) arrangement) or symmetry.

/ear that negati2e or aggressi2e thoughts or impulses will ,ause personal harm or harm to a

lo2ed one.

Preo,,upation with losing or throwing away obje,ts with little or no 2alue.

B4,essi2e ,on,ern about a,,identally or purposeully injuring another person.

/eeling o2erly responsible or the saety o others.

!istasteul religious and se4ual thoughts or images.

!oubting that is irrational or e4,essi2e.
http://www.adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad/symptomshttp://www.adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad/symptomshttp://www.adaa.org/finding-help/treatment/therapyhttp://www.adaa.org/finding-help/treatment/medicationhttp://www.adaa.org/finding-help/treatment/complementary-alternative-treatmenthttp://adaa.org/understanding-anxiety/obsessive-compulsive-disorder-ocd/symptomshttp://adaa.org/understanding-anxiety/obsessive-compulsive-disorder-ocd/symptomshttp://adaa.org/living-with-anxiety/childrenhttp://www.adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad/symptomshttp://www.adaa.org/finding-help/treatment/therapyhttp://www.adaa.org/finding-help/treatment/medicationhttp://www.adaa.org/finding-help/treatment/complementary-alternative-treatmenthttp://adaa.org/understanding-anxiety/obsessive-compulsive-disorder-ocd/symptomshttp://adaa.org/living-with-anxiety/children


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Compulsions ritualistic behaviors and routines to ease anxiety or distress ;leaning G epeatedly washing one>s hands) bathing) or ,leaning household items) oten or

hours at a time.

;he,king G ;he,king and re-,he,king se2eral to hundreds o times a day that the doors are

lo,ked) the sto2e is turned o) the hairdryer is unplugged) et,.

epeating G nability to stop repeating a name) phrase) or simple a,ti2ity (su,h as going

through a doorway o2er and o2er. 7oarding G !ii,ulty throwing away useless items su,h as old newspapers or magaCines)

bottle ,aps) or rubber bands.

5ou,hing and arranging

Mental rituals G Bndless re2iewing o ,on2ersations) ,ounting9 repetiti2ely ,alling up =goodH

thoughts to neutraliCe =badH thoughts or obsessions9 or e4,essi2e praying and using spe,ial

words or phrases to neutraliCe obsessions.

TreatmentO;! is a serious) yet treatable an4iety disorder that oten o,,urs with depressionand other an4iety

disorders. not treated properly) it may be,ome disabling.

Most people who seek treatment e4perien,e signii,ant impro2ement and enjoy an impro2ed Fuality o

lie. t is important to work ,losely with a health ,are proessional to determine the best option.

you>re ,on,erned about symptoms o O;!) make an appointment with a therapist or your

do,tor.5hen ,omplete the sel-test on this site.


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Are you a pro2ider or my insuran,eI

s payment e4pe,ted at the time o my treatmentI

At the First Session

7ow did you diagnose that ha2e O;!I

hat i also ha2e other an4iety disorders or depressionI

hat ,auses O;!I !oes it run in amiliesI hat kind o treatment approa,h do you think is best or my problemI

hat is ;15I 7ow well does it work or O;!I

hat are the side ee,ts o medi,ationI

hat i the medi,ation doesn>t workI

hen ,an e4pe,t to see resultsI

s a ,ombination o medi,ation and ;15 best or meI

7ow long do you e4pe,t treatment to lastI

hat i ha2e a relapseI

u,,essul treatment oten in,ludes a ,ombination o beha2ior therapy) su,h as ,ogniti2e-beha2ioral

therapy or e4posure therapy) and medi,ation. Dearn more about treating O;! and an4iety disorders.

Hoarding: The Basics(+ve al*ays had trouble thro*ing things a*ay. #aga,ines ne*spapers old clothes "hat if ( need

them one day/ ( don+t *ant to risk thro*ing something out that might be valuable. he large piles of

stuff in our house keep gro*ing so it+s difficult to move around and sit or eat together as a family.

#y husband is upset and embarrassed and *e get into horrible fights. (+m scared *hen he threatens

to leave me. #y children *on+t invite friends over and ( feel guilty that the clutter makes them cry.

&ut ( get so an0ious *hen ( try to thro* anything a*ay. ( don+t kno* *hat+s *rong *ith me and ( don+t

kno* *hat to do.

5his e4ample is typi,al o someone who suers rom hoarding. ead on to learn more) in,luding the

dieren,es between hoarding and ,olle,ting.

Understanding Hoarding7oarding is the persistent dii,ulty dis,arding or parting with possessions) regardless o their a,tual2alue. 5he beha2ior usually has deleterious ee,tsGemotional) physi,al) so,ial) inan,ial) and e2en

legalGor a hoarder and amily members.

/or those who hoard) the Fuantity o their ,olle,ted items sets them apart rom other people.

;ommonly hoarded items may be newspapers) magaCines) paper and plasti, bags) ,ardboard bo4es)

photographs) household supplies) ood) and ,lothing.

/ind out all about animal hoarding.

7oarding ,an be related to ,ompulsi2e buying (su,h as ne2er passing up a bargain) the ,ompulsi2e

a,Fuisition o ree items (su,h as ,olle,ting lyers) or the ,ompulsi2e sear,h or pere,t or uniFue

items (whi,h may not appear to others as uniFue) su,h as an old ,ontainer.

Symptoms and Behavioromeone who hoards may e4hibit the ollowing:

nability to throw away possessions

e2ere an4iety when attempting to dis,ard items

*reat dii,ulty ,ategoriCing or organiCing possessions

nde,ision about what to keep or where to put things

!istress) su,h as eeling o2erwhelmed or embarrassed by possessions
http://www.adaa.org/finding-help/treatmenthttp://www.adaa.org/living-with-anxiety/ask-and-learn/ask-expert/what-animal-hoarding-it-hoarding-lots-objects-can-peoplhttp://www.adaa.org/finding-help/treatmenthttp://www.adaa.org/living-with-anxiety/ask-and-learn/ask-expert/what-animal-hoarding-it-hoarding-lots-objects-can-peopl


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ear o being ,onsidered a hypo,hondria,. nstead they suer in silen,e) distan,ing themsel2es rom

riends) amily) and others who ,ould be helpul or supporti2e.

!ownload the ,harts ound inFacing Panic)%elf-Help for People *ith Panic Attacks to

help you pra,ti,e and tra,k the skills you learn to o2er,ome your pani,.

;hart ": Pra,ti,ing the ;alming kills

;hart +: Pra,ti,e ;reating ymptoms

;hart ': Pra,ti,e ;reating ymptoms

;hart &: Disting L anking My /eared ituations

;hart 3: !etails o My /eared ituations;hart 6: Preparing to Pra,ti,e

;hart $: Dearning rom Pra,ti,e

5he disorder oten o,,urs with other mental and physi,al disorders) in,luding other an4iety disorders)

depression) irritable bowel syndrome) asthma) or substan,e abuse. 5his may ,ompli,ate o getting a

,orre,t diagnosis.

Agoraphobiaome people stop going into situations or pla,es in whi,h theyJ2e pre2iously had a pani, atta,k in

anti,ipation o it happening again.

5hese people ha2e agoraphobia) and they typi,ally a2oid publi, pla,es where they eel immediate

es,ape might be dii,ult) su,h as shopping malls) publi, transportation) or large sports arenas. Aboutone in three people with pani, disorder de2elops agoraphobia. 5heir world may be,ome smaller as

they are ,onstantly on guard) waiting or the ne4t pani, atta,k. ome people de2elop a i4ed route or

territory) and it may be,ome impossible or them to tra2el beyond their saety Cones without suering

se2ere an4iety.

SymptomsA pani, atta,k is deined as the abrupt onset o intense ear that rea,hes a peak within a ew minutes

and in,ludes at least our o the ollowing symptoms:

a eeling o imminent danger or doom

the need to es,ape

heart palpitations

sweating

trembling

shortness o breath or a smothering eeling

a eeling o ,hoking

,hest pain or dis,omort

nausea or abdominal dis,omort

diCCiness or lightheadedness
http://www.adaa.org/netforum/shoppinghttp://www.adaa.org/netforum/shoppinghttp://www.adaa.org/netforum/shoppinghttp://www.adaa.org/netforum/shoppinghttp://www.adaa.org/netforum/shoppinghttp://www.adaa.org/sites/default/files/chart1.pdfhttp://www.adaa.org/sites/default/files/chart2.pdfhttp://www.adaa.org/sites/default/files/chart3.pdfhttp://www.adaa.org/sites/default/files/chart4_0.pdfhttp://www.adaa.org/sites/default/files/chart5_0.pdfhttp://www.adaa.org/sites/default/files/chart6_0.pdfhttp://www.adaa.org/sites/default/files/chart7_0.pdfhttp://www.adaa.org/netforum/shoppinghttp://www.adaa.org/sites/default/files/chart1.pdfhttp://www.adaa.org/sites/default/files/chart2.pdfhttp://www.adaa.org/sites/default/files/chart3.pdfhttp://www.adaa.org/sites/default/files/chart4_0.pdfhttp://www.adaa.org/sites/default/files/chart5_0.pdfhttp://www.adaa.org/sites/default/files/chart6_0.pdfhttp://www.adaa.org/sites/default/files/chart7_0.pdf


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24/56

Reacting to a Traumatic Eventt>s not unusual or people who ha2e e4perien,ed traumati, e2ents to ha2e lashba,ks) nightmares) or

intrusi2e memories when something terrible happens -- like the e4plosions at the 1oston Marathon.

1e tolerant o your ner2ous system: t>s ha2ing a normal rea,tion. 5ry not to get hooked to news

reports) whi,h may seem parti,ularly ,ompelling. pend time with lo2ed ones in a2orite a,ti2ities or

outside in nature) and a2oid al,ohol.

Dearn more below) in,luding how to help ,hildren.

Posttraumatic stress disorder, or PTSD,is a serious potentially debilitating ,ondition that ,an

o,,ur in people who ha2e e4perien,ed or witnessed a natural disaster) serious a,,ident) terrorist

in,ident) sudden death o a lo2ed one) war) 2iolent personal assault su,h as rape) or other lie-

threatening e2ents.

Most people who e4perien,e su,h e2ents re,o2er rom them) but people with P5! ,ontinue to be

se2erely depressed and an4ious or months or e2en years ollowing the e2ent. Dearn about P5!

symptoms.

omen are twi,e as likely to de2elop posttraumati, stress disorder as men) and ,hildren ,an also

de2elop it. P5! oten o,,urs with depression) substan,e abuse) or other an4iety disorders.

7elp


25/56

dire,tly e4perien,ing the traumati, e2ents

witnessing) in person) the traumati, e2ents

learning that the traumati, e2ents o,,urred to a ,lose amily member or ,lose riend9 ,ases o

a,tual or threatened death must ha2e been 2iolent or a,,idental

e4perien,ing repeated or e4treme e4posure to a2ersi2e details o the traumati, e2ents

(B4amples are irst responders ,olle,ting human remains9 poli,e oi,ers repeatedly e4posed to

details o ,hild abuse. Note$ his does not apply to e0posure through electronic mediatelevision movies or pictures unless e0posure is *ork-related.

5he presen,e o one or more o the ollowing:

spontaneous or ,ued re,urrent) in2oluntary) and intrusi2e distressing memories o the

traumati, e2ents 1Note$ (n children repetitive play may occur in *hich themes or aspects of the

traumatic events are e0pressed.2

re,urrent distressing dreams in whi,h the ,ontent or ae,t (i.e. eeling o the dream is related

to the e2ents 1Note$ (n children there may be frightening dreams *ithout recogni,able content.2

lashba,ks or other disso,iati2e rea,tions in whi,h the indi2idual eels or a,ts as i the

traumati, e2ents are re,urring 1Note$ (n children trauma-specific reenactment may occur in play.2

intense or prolonged psy,hologi,al distress at e4posure to internal or e4ternal ,ues that

symboliCe or resemble an aspe,t o the traumati, e2ents

physiologi,al rea,tions to reminders o the traumati, e2ents

Persistent a2oidan,e o distressing memories) thoughts) or eelings about or ,losely asso,iated with

the traumati, e2ents or o e4ternal reminders (i.e.) people) pla,es) ,on2ersations) a,ti2ities) obje,ts)

situations

5wo or more o the ollowing:

inability to remember an important aspe,t o the traumati, e2ents (not due to head injury)

al,ohol) or drugs

persistent and e4aggerated negati2e belies or e4pe,tations about onesel) others) or the world

(e.g.) = am bad)H =No one ,an be trusted)H 5he world is ,ompletely dangerous.

persistent) distorted blame o sel or others about the ,ause or ,onseFuen,es o the traumati,

e2ents

persistent ear) horror) anger) guilt) or shame

markedly diminished interest or parti,ipation in signii,ant a,ti2ities

eelings o deta,hment or estrangement rom others

persistent inability to e4perien,e positi2e emotions

5wo or more o the ollowing marked ,hanges in arousal and rea,ti2ity:

irritable or aggressi2e beha2ior

re,kless or sel-destru,ti2e beha2ior

hyper2igilan,e

e4aggerated startle response

problems with ,on,entration

dii,ulty alling or staying asleep or restless sleep

Also) ,lini,ally signii,ant distress or impairment in so,ial) o,,upational) or other important areas o

un,tioning not attributed to the dire,t physiologi,al ee,ts o medi,ation) drugs) or al,ohol or another

medi,al ,ondition) su,h as traumati, brain injury.

Dearn about P5! symptoms in ,hildren age si4 and younger.

,reen yoursel or a amily memberor P5!.

;he,k out the mobile app P5! ;oa,h)rom the ?.. !epartment o eterans Aairs.

Treatment
http://www.adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd/living-with-anxiety/children/posttraumatic-stress-disorder-ptsd/symptomshttp://www.adaa.org/living-with-anxiety/ask-and-learn/screenings/screening-posttraumatic-stress-disorder-ptsdhttp://www.ptsd.va.gov/public/pages/PTSDCoach.asphttp://www.ptsd.va.gov/public/pages/PTSDCoach.asphttp://www.adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd/living-with-anxiety/children/posttraumatic-stress-disorder-ptsd/symptomshttp://www.adaa.org/living-with-anxiety/ask-and-learn/screenings/screening-posttraumatic-stress-disorder-ptsdhttp://www.ptsd.va.gov/public/pages/PTSDCoach.asp


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5he main treatments or people with P5! are psy,hotherapy (oten ,alled talk therapy) medi,ations)

or both. B2eryone is dierent) so a treatment that works or one person may not work or another.

t is important or anyone with P5! to be treated by a mental health ,are proessional who is

e4perien,ed with P5!. ome people will need to try dierent treatments to ind what works or their

symptoms.

Cognitie!"ehaioral therap#) or ;15) ,an be helpul. hat is ;15IDisten to this pod,ast.

$%posure therap#.5his therapy helps people a,e and ,ontrol their ear by e4posing them to the

trauma they e4perien,ed in a sae way. t uses mental imagery) writing) or 2isits to the pla,e where

the e2ent happened. 5he therapist uses these tools to help people with P5! ,ope with their eelings.

Cognitie restructuring.5his therapy helps people make sense o the bad memories. ometimes

people remember the e2ent dierently than how it happened. 5hey may eel guilt or shame about

what is not their ault. 5he therapist helps people with P5! look at what happened in a realisti, way.

Stress inoculation training.5his therapy tries to redu,e P5! symptoms by tea,hing a person how

to redu,e an4iety. Dike ,ogniti2e restru,turing) this treatment helps people look at their memories in a

healthy way.

&irtual realit# treatment,onsists o ,ustom 2irtual en2ironments that ha2e been ,areully designedto support e4posure therapy o an4iety disorders. 5he treatment in2ol2es e4posing the person with

P5! to a 2irtual en2ironment that ,ontains the eared situation) instead o taking the patient into the

a,tual en2ironment or ha2ing the patient imagine the traumati, situation.

5he therapist ,ontrols the 2irtual en2ironment through a ,omputer keyboard) ensuring ull ,ontrol o

the e4posure and the ability manipulate situations to best suit the person within the ,onines o a

therapistJs oi,e.

ead a trans,ript o a dis,ussion with e4perts:5reating An4iety with irtual eality B4posure

/ind out more about treatment.

Social Anxiety Disordert>s the e4treme ear o being s,rutiniCed and judged by others in so,ial or perorman,e situations:

o,ial an4iety disorder ,an wreak ha2o, on the li2es o those who suer rom it. 5his disorder

isnot simply shyness that has been inappropriately medi,aliCed:ead about the dieren,e.

ymptoms may be so e4treme that they disrupt daily lie. People with this disorder) also ,alled so,ial

phobia) may ha2e ew or no so,ial or romanti, relationships) making them eel powerless) alone) or

e2en ashamed.

About "3 million Ameri,an adults ha2e so,ial an4iety disorder

5ypi,al age o onset: "' years old

'6 per,ent o people with so,ial an4iety disorder report symptoms or "0 or more years beore

seeking helpAlthough they re,ogniCe that the ear is e4,essi2e and unreasonable) people with so,ial an4iety

disorder eel powerless against their an4iety. 5hey are terriied they will humiliate or embarrass

themsel2es.

5he an4iety ,an interere signii,antly with daily routines) o,,upational perorman,e) or so,ial lie)

making it dii,ult to ,omplete s,hool) inter2iew and get a job) and ha2e riendships and romanti,

relationships.
http://www.adaa.org/resources-professionals/podcasts/cbt-what-ithttp://www.adaa.org/resources-professionals/podcasts/cbt-what-ithttp://www.medicinenet.com/script/main/art.asp?articlekey=53957http://www.adaa.org/finding-help/treatmenthttp://www.nimh.nih.gov/science-news/2011/national-survey-dispels-notion-that-social-phobia-is-the-same-as-shyness.shtmlhttp://www.nimh.nih.gov/science-news/2011/national-survey-dispels-notion-that-social-phobia-is-the-same-as-shyness.shtmlhttp://www.nimh.nih.gov/science-news/2011/national-survey-dispels-notion-that-social-phobia-is-the-same-as-shyness.shtmlhttp://www.adaa.org/resources-professionals/podcasts/cbt-what-ithttp://www.medicinenet.com/script/main/art.asp?articlekey=53957http://www.adaa.org/finding-help/treatmenthttp://www.nimh.nih.gov/science-news/2011/national-survey-dispels-notion-that-social-phobia-is-the-same-as-shyness.shtml


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Most o us eel a degree o ner2ous apprehension when preparing to speak up or perorm in ront o a

group. 1ut those who are illed with eelings o dread and pani, in su,h a situationGor anywhere the

person might be ,enter o attentionGmay be suering rom a orm oso,ial an4iety disorder(also

known as so,ial phobia.

5he ear o publi, speaking or perorman,e) oten ,alled stage right) e4a,ts a huge toll on sel-

,oniden,e and sel-esteem and ,auses some people to lea2e s,hool or a job or pass up a promotion.

Many) in,luding seasoned proessional perormers) suer in silent terror. And be,ause they eel

embarrassed) people try to keep their ear a se,ret) e2en rom a spouse or other ,lose amily members

or riends.

Taking Steps to Overcome Your FearDearning to impro2e your speaking or perorman,e skills is good) but it>s generally not enough to

substantially redu,e your ear. s oten helpul to

un,o2er the deeper ears related to being seen and heard by others) showing 2ulnerability) and being

,onsidered less than pere,t. Dearning to a,,ept yoursel and not eeling that you ha2e to pro2e

yoursel to others is at the root o healing.

t is re,ommended that you learn skills to redu,e and manage your ear and an4iety and not resort to

using medi,ation or natural produ,ts alone. t>s also ,riti,al to learn ,ogniti2e-beha2ioral methodsto

stop the ,y,le o a2oiding earul situations. A2oidan,e may gi2e you immediate relie) but it reinor,es

your ear in the long run.

ome people also ,hoose medi,ation or natural remedies to help redu,e their symptoms o

perorman,e an4iety. 5alk with your physi,ian to ind the most appropriate treatment or you.

you are willing stop a2oiding your ears and learn new skills to redu,e and manage them) you will

de2elop an empowering belie and trust in yoursel. n a,ing your ear) it be,omes possible to

o2er,ome perorman,e an4iety and ind ,omort and ease in e4pressing yoursel in ront o others.

Tr# these '( tips to reduce #our stage fright)

". hit the o,us rom yoursel and your ear to your true purposeG,ontributing something o

2alue to your audien,e.+. top s,aring yoursel with thoughts about what might go wrong. nstead) o,us your attention

on thoughts and images that are ,alming and reassuring.

'. euse to think thoughts that ,reate sel-doubt and low ,oniden,e.

&. Pra,ti,e ways to ,alm and rela4 your mind and body) su,h as deep breathing) rela4ation

e4er,ises) yoga) and meditation.

3. B4er,ise) eat well) and pra,ti,e other healthul liestyle habits. 5ry to limit ,aeine) sugar) and

al,ohol as mu,h as possible.

6. isualiCe your su,,ess: Always o,us on your strength and ability to handle ,hallenging

situations.

$. Prepare your material in ad2an,e and read it aloud to hear your 2oi,e.

%. Make ,onne,tions with your audien,e: mile and greet people) thinking o them as riends

rather than enemies.

#. tand or sit in a sel-assured) ,onident posture. emain warm and open and make eye,onta,t.

"0. *i2e up trying to be pere,t and know that it is OK to make mistakes. 1e natural) be yoursel.

8anet Bsposito) M)who o2er,ame her own terror o publi, speaking) is the author o se2eral books

about resol2ing ears o publi, speaking and perorming.

Scientific *eferences

tein) M.1.) alker) 8..) L /orde) !.. ("##6. Publi, speaking ears in the ,ommunity: Pre2alen,e)

impa,t on un,tioning) and diagnosti, ,lassii,ation.Archives of General Psychiatry 3') "6#-"$&.

tein) M.1.) alker) 8..) L /orde) !.. ("##&. etting diagnosti, thresholds or so,ial phobia:
http://www.adaa.org/understanding-anxiety/social-anxiety-disorderhttp://www.adaa.org/finding-help/treatment/therapy%20%20http://www.adaa.org/finding-help/treatment/therapy%20%20http://www.performanceanxiety.com/http://www.adaa.org/finding-help/self-help-bookshttp://www.adaa.org/finding-help/self-help-bookshttp://www.adaa.org/finding-help/self-help-bookshttp://www.adaa.org/understanding-anxiety/social-anxiety-disorderhttp://www.adaa.org/finding-help/treatment/therapy%20%20http://www.performanceanxiety.com/http://www.adaa.org/finding-help/self-help-bookshttp://www.adaa.org/finding-help/self-help-books


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;onsiderations rom a ,ommunity sur2ey o so,ial an4iety.American )ournal of Psychiatry "3") &0%-

&"+.

Self-Help

riumph 3ver %hyness$ 4on5uering %ocial An0iety 'isorder %econd 6dition is ull o pra,ti,al tips)helpul te,hniFues) and more to help manage an4ious thoughts and physi,al symptoms o so,ial

an4iety disorder.

?sing humor) warmth) and language that is easy to understand) authors Murray tein) M!) MP7) and

8ohn alker) Ph!) e4plain what ,auses so,ial an4iety disorder) how it impa,ts so,ial and romanti,

relationships) and what treatments work. Order your ,opy today.

Social Anxiety Disorder and Alcohol AbuseAt around the age of 78 ( became a*are that ( *as different. ( felt intense social an0iety. ( had no

skills to use to interact socially *ith my peers. ( *as 5uiet and blended into the *alls. ( didn+t trust my

perceptions and it took many years before ( could admit much less say aloud ho* ( felt.

5hese are the words o ;ynthia Kipp) who has so,ial an4iety disorder.

#y family didn+t seem to pay too much attention to my phobia. ( did *hat *as e0pected as a 9good:

girl.

;ynthia>s tumultuous ,hildhood her ather was abusi2e and suered rom s,hiCophrenia ,oupled

with so,ial an4iety led to dii,ult teenage years. he didn>t eel part o any group o riends) and she

started drinking to alle2iate her an4iety around her peers.

1ut her drinking soon be,ame as big o a problem as her an4iety) i not bigger.

About "3 million ?.. adults) or $ per,ent o the population) ha2e so,ial an4iety disorderin any gi2en

year. And it isn>t unusual or people with so,ial an4iety disorder or other an4iety disorders to drink

e4,essi2ely to ,ope with symptoms or try to es,ape them.

Murray tein) M!) MP7) and 8ohn alker) Ph!) write in riumph 3ver %hyness$ 4on5uering %ocial

An0iety 'isorderthat so,ial an4iety disorder =reFuently tra2els in the ,ompany o other emotionaldii,ultiesH su,h as al,ohol or drug abuse) depression) and other an4iety disorders.

Symptoms#y drinking *as self-destructive and that compounded my lo* self-esteem.

About +0 per,ent o people with so,ial an4iety disorder also suer rom al,ohol abuse or dependen,e)

and a re,ent study ound that the two disorders ha2e a stronger ,onne,tion among women.

Although al,ohol ,an temporarily redu,e symptoms o so,ial an4iety whi,h is the reason many turn

to it tein and alker note that al,ohol ,an also in,rease an4iety) irritability) or depression a ew

hours later or the ne4t day. B2en moderate amounts o al,ohol ,an ae,t one>s mood and an4iety

le2el.

you do at least one o the ollowing) you may suer rom al,oholism:

!rink al,ohol our or more times a week

7a2e i2e or more drinks ,ontaining al,ohol in one day

Not be able to stop drinking on,e you>2e started

Need a drink in the morning to get yoursel going

/eel guilty or remorseul ater drinking

7eard a relati2e) riend) ,o-worker) or do,tor e4press ,on,ern about your drinking or suggest

you ,ut down
http://www.adaa.org/netforum/shoppinghttp://www.adaa.org/netforum/shoppinghttp://www.adaa.org/understanding-anxiety/social-anxiety-disorderhttp://www.adaa.org/netforum/shoppinghttp://www.adaa.org/netforum/shoppinghttp://www.adaa.org/netforum/shoppinghttp://www.adaa.org/netforum/shoppinghttp://www.adaa.org/understanding-anxiety/social-anxiety-disorderhttp://www.adaa.org/netforum/shoppinghttp://www.adaa.org/netforum/shopping


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B4,essi2e drinking ,an lead to addi,tion and delay the desire to seek treatment and interere with the

ee,ti2eness o therapy or medi,ation on,e on a treatment plan.

Treatment3n the verge of losing everything and not really kno*ing myself ( started attending AA meetings. For

the first year ( couldn+t speak. Finally ( shared my story. %peaking at meetings slo*ly gave me

confidence to speak in front of others.;ynthia ,redits Al,oholi,s Anonymous meetings or not only helping her with her al,ohol problem) but

or putting her on the path to o2er,oming her so,ial an4iety.

5he meetings allowed her to gradually be,ome ,omortable speaking beore other people) and on,e

she be,ame sober) ;ynthia ,ould o,us on urther redu,ing her so,ial an4iety disorder symptoms

through therapy. /ind an AA meeting near you.

ome people with so,ial an4iety) howe2er) ind AA meetings and other support groups to be too

an4iety-pro2oking. orking one-on-one with a do,tor or therapist with e4perien,e in treating an4iety

disorders may be best and ,an help one prepare to su,,essully parti,ipate in an al,ohol treatment

program at a later time./ind a therapist near you.

A re,ent ,lini,al study also ound that a ,ombination o ,ogniti2e-beha2ioral therapy(;15 and

moti2ational enhan,ement therapy (MB5 may be su,,essul in treating ,o-o,,urring so,ial an4iety

disorder and al,ohol abuse. Moti2ational enhan,ement therapy is used in drug abuse ,ounseling and

en,ourages patients to turn their desire to ,hange into ,on,rete goals to do so.

ResourcesAl,oholi,s Anonymous or people with drinking problems

Al-Anon and Alateen or riends and amily o al,oholi,s

/ind a 5herapist sear,h the A!AA dire,tory using your Cip ,ode or ,ity and state

Recommended booksriumph 3ver %hyness$ 4on5uering %ocial An0iety 'isorder A!AA publi,ation ull o pra,ti,al tips)

helpul te,hniFues) and more to help manage an4ious thoughts and physi,al symptoms o so,ial

an4iety disorder

Specific PhobiasNew pla,es) high bridges) old ele2ators may make all o us a bit uneasy or e2en rightened. e might

try to a2oid things that make us un,omortable) but most people generally manage to ,ontrol their

ears and ,arry out daily a,ti2ities without in,ident.

1ut people with spe,ii, phobias) or strong irrational ear rea,tions) work hard to a2oid ,ommon

pla,es) situations) or obje,ts e2en though they know thereJs no threat or danger. 5he ear may not

make any sense) but they eel powerless to stop it.

People who e4perien,e these seemingly e4,essi2e and unreasonable ears in the presen,e o or in

anti,ipation o a spe,ii, obje,t) pla,e) or situation ha2e a spe,ii, phobia.

7a2ing phobias ,an disrupt daily routines) limit work ei,ien,y) redu,e sel-esteem) and pla,e a strain

on relationships be,ause people will do whate2er they ,an to a2oid the un,omortable and oten-

terriying eelings o phobi, an4iety.

hile some phobias de2elop in ,hildhood) most seem to arise une4pe,tedly) usually during

adoles,en,e or early adulthood. 5heir onset is usually sudden) and they may o,,ur in situations that

pre2iously did not ,ause any dis,omort or an4iety.
http://www.aa.org/http://www.aa.org/http://www.adaa.org/netforum/findatherapisthttp://www.adaa.org/netforum/findatherapisthttp://www.adaa.org/finding-help/treatment/therapyhttp://www.aa.org/http://www.al-anon.alateen.org/http://www.adaa.org/netforum/findatherapisthttp://www.adaa.org/netforum/shoppinghttp://www.aa.org/http://www.adaa.org/netforum/findatherapisthttp://www.adaa.org/finding-help/treatment/therapyhttp://www.aa.org/http://www.al-anon.alateen.org/http://www.adaa.org/netforum/findatherapisthttp://www.adaa.org/netforum/shopping


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pe,ii, phobias ,ommonly o,us on animals) inse,ts) germs) heights) thunder) dri2ing) publi,

transportation) lying) dental or medi,al pro,edures) and ele2ators.

Although people with phobias realiCe that their ear is irrational) e2en thinking about it ,an oten ,ause

e4treme an4iety.

Symptomsymptoms o ha2ing a spe,ii, phobia oten in,lude un,omortable and terriying eelings o an4iety:

a eeling o imminent danger or doom

the need to es,ape

heart palpitations

sweating

trembling

shortness o breath or a smothering eeling

a eeling o ,hoking

,hest pain or dis,omort

nausea or abdominal dis,omort

eeling aint) diCCy or lightheaded

a sense o things being unreal) depersonaliCation

a ear o losing ,ontrol or =going ,raCyH

a ear o dying

tingling sensation

,hills or heat lush

,reen yoursel or a amily memberor a spe,ii, phobia.

t>s important to note the dieren,e between e2eryday an4iety and a phobia:

Treatment5he 2ast majority o people with an an4iety disorder ,an be helped with proessional ,are.

$er#da# An%iet# Pho"ia

/eeling Fueasy while ,limbing atall ladder

eusing to attend your best riend>s weddingbe,ause it>s on the +3th loor o a hotel

orrying about taking o in anairplane during a lightning storm

5urning down a big promotion be,ause itin2ol2es air tra2el

/eeling an4ious around yourneighbor>s pit bull

A2oiding 2isiting your neighbors or ear oseeing a dog
http://www.adaa.org/living-with-anxiety/ask-and-learn/screenings/screening-specific-phobiashttp://www.adaa.org/living-with-anxiety/ask-and-learn/screenings/screening-specific-phobias


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u,,ess o treatment 2aries among people. ome may respond to treatment ater a ew months) while

others may need more than a year. 5reatment may be ,ompli,ated i people ha2e more than one

an4iety disorder or suer rom depression or substan,e abuse. 5his is why treatment must be tailored

to the indi2idual.

Although treatment is indi2idualiCed) se2eral standard approa,hes) parti,ularly ,ogniti2e-beha2ioral

therapy) ha2e pro2ed ee,ti2e. 5herapists will use one or a ,ombination o these therapies. Dearn

more about treatment.

Cognitive-Behavioral Therapyn general) ,ogniti2e-beha2ioral therapy (;15 ,an work or those with spe,ii, phobia. eekly

treatment with homework assignments usually su,,eeds in "+ to"6 sessions. /irst the therapist helps

the patient understand in,orre,t assumptions and then gradually e4poses him or her to the phobia

sour,e.

hat a therapist usually does in the irst ,ouple o sessions is help people identiy mistaken belies.

People with phobias ,atastrophiCe9 they immediately jump to the worst-,ase s,enario) and they

o2erestimate the probability that it will happen. 5herapists help them realiCe they are making those

mistakes) and they talk about realisti, risks. People are unlikely to be hit by lightening) or e4ample)

and their house will probably not ,at,h ire) or e4ample.

e,ondly ,omes e4posure) or ,onronting the eared situation) su,h as going with a therapist and

getting ,loser to dogs. Another e4ample is a thunderstorm) whi,h would not mean holding up a metal

bat in a storm. 5he therapist and patient would go into a house and stand near a window) learning to

take a,,eptable risks that are relati2ely sae.

DepressionMost people eel an4ious or depressed at times. Dosing a lo2ed one) getting ired rom a job) going

through a di2or,e) and other dii,ult situations ,an lead a person to eel sad) lonely) s,ared) ner2ous)

or an4ious. 5hese eelings are normal rea,tions to lieJs stressors.

1ut some people e4perien,e these eelings daily or nearly daily or no apparent reason) making itdii,ult to ,arry on with normal) e2eryday un,tioning. 5hese people may ha2e an an4iety disorder)

depression) or both.

t is not un,ommon or someone with an an4iety disorder to also suer rom depression or 2i,e 2ersa.

Nearly one-hal o those diagnosed with depression are also diagnosed with an an4iety disorder. 5he

good news is that these disorders are both treatable) separately and together.

ead on to ind out more about the ,o-o,,urren,e o an4iety and depression")+ and how they ,an be

treated.

Depression!epression is a ,ondition in whi,h a person eels dis,ouraged) sad) hopeless) unmoti2ated) or

disinterested in lie in general. hen these eelings last or a short period o time) it may be a ,ase othe blues.

1ut when su,h eelings last or more than two weeks and when the eelings interere with daily

a,ti2ities su,h as taking ,are o amily) spending time with riends) or going to work or s,hool) itJs likely

a major depressi2e episode.

at,h a personal story about the importan,e o seeking help.
http://www.adaa.org/finding-help/treatmenthttp://www.adaa.org/finding-help/treatmenthttp://www.adaa.org/finding-help/treatment/therapyhttp://www.adaa.org/about-adaa/press-room/multimedia/anxiety-storieshttp://www.adaa.org/finding-help/treatmenthttp://www.adaa.org/finding-help/treatmenthttp://www.adaa.org/finding-help/treatment/therapyhttp://www.adaa.org/about-adaa/press-room/multimedia/anxiety-stories


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Major depression is a treatable illness that ae,ts the way a person thinks) eels) beha2es) and

un,tions. At any point in time) ' to 3 per,ent o people suer rom major depression9 the lietime risk

is about "$ per,ent.

,reen yoursel or a lo2ed one or depression.

Types of depression

5hree main types o depressi2e disordersGmajor depression) dysthymia) and bipolar disorderG,ano,,ur with any o the an4iety disorders.

Ma+or depressionin2ol2es at least i2e o these symptomsor a two-week period. u,h an episode is

disabling and will interere with the ability to work) study) eat) and sleep. Major depressi2e episodes

may o,,ur on,e or twi,e in a lietime) or they may re-o,,ur reFuently. 5hey may also take pla,e

spontaneously) during or ater the death o a lo2ed one) a romanti, breakup) a medi,al illness) or other

lie e2ent.

ome people with major depression may eel that lie is not worth li2ing and some will attempt to end

their li2es.

D#sth#miais a less se2ere) long-term) and ,hroni, orm o depression. t in2ol2es the

samesymptomsas major depression) mainly low energy) poor appetite or o2ereating) and insomnia or

o2ersleeping. t ,an maniest as stress) irritability) and mild anhedonia) whi,h is the inability to deri2e

pleasure rom most a,ti2ities.

People with dysthymia might be thought o as always seeing the glass as hal empty.

Bipolar disorder,on,e ,alled mani,-depression) is ,hara,teriCed by a mood ,y,le that shits rom

se2ere highs (mania or mild highs (hypomania to se2ere lows (depression.

at,h a personal story about the importan,e o seeking help.

!uring the mani, phase) a person may e4perien,e abnormal or e4,essi2e elation) irritability) a

de,reased need or sleep) grandiose notions) in,reased talking) ra,ing thoughts) in,reased se4ual

desire) markedly in,reased energy) poor judgment) and inappropriate so,ial beha2ior.

!uring the depressi2e phase) a person e4perien,es the same symptomsas would a suerer o major

depression. Mood swings rom mani, to depressi2e are oten gradual) although o,,asionally they ,an

o,,ur abruptly. Dearn more about bipolar disorder.

Depression and anxiety disorders: not the same!epression and an4iety disorders are dierent) but people with depression oten e4perien,e symptoms

similar to those o an an4iety disorder) su,h as ner2ousness) irritability) and problems sleeping and

,on,entrating. 1ut ea,h disorder has its own ,auses and its own emotional and beha2ioral symptoms.

Many people who de2elop depression ha2e a history o an an4iety disorder earlier in lie. 5here is no

e2iden,e one disorder ,auses the other) but there is ,lear e2iden,e that many people suer rom both

disorders.

ead more inormation about depression rom the National nstitute o Mental 7ealth.

". 1arbee) 8. *. ("##%. Mi4ed symptoms and syndromes o an4iety and depression: !iagnosti,)prognosti,) and etiologi, issues.Annals of 4linical Psychiatry"0:"3+#.

+. egier) !. A.) ae) !. .) Narrow) . B.) Kaelber) ;. 5.) L ,hatCberg) A. /. ("##%. Pre2alen,e o

an4iety disorders and their ,omorbidity with mood and addi,ti2e disorders.&ritish )ournal of

Psychiatry.%upplement'&: +&+%.

SymptomsA major depressi2e episode may in,lude these symptoms:
http://www.adaa.org/iving-with-anxiety/ask-and-learn/screenings/screening-depressionhttp://www.adaa.org/understanding-anxiety/depression/symptomshttp://www.adaa.org/understanding-anxiety/depression/symptomshttp://www.adaa.org/understanding-anxiety/related-illnesses/bipolar-disorderhttp://www.adaa.org/understanding-anxiety/related-illnesses/bipolar-disorderhttp://www.adaa.org/about-adaa/press-room/multimedia/anxiety-storieshttp://www.adaa.org/understanding-anxiety/depression/symptomshttp://www.healthline.com/health/bipolar-disorderhttp://www.nimh.nih.gov/health/publications/depression/complete-index.shtml#pub4http://www.adaa.org/iving-with-anxiety/ask-and-learn/screenings/screening-depressionhttp://www.adaa.org/understanding-anxiety/depression/symptomshttp://www.adaa.org/understanding-anxiety/depression/symptomshttp://www.adaa.org/understanding-anxiety/related-illnesses/bipolar-disorderhttp://www.adaa.org/about-adaa/press-room/multimedia/anxiety-storieshttp://www.adaa.org/understanding-anxiety/depression/symptomshttp://www.healthline.com/health/bipolar-disorderhttp://www.nimh.nih.gov/health/publications/depression/complete-index.shtml#pub4


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egular e4er,ise ,an redu,e symptoms o depression and an4iety.

Choosing a TherapistMembers o the An4iety !isorders Asso,iation o Ameri,a who spe,ialiCe in an4iety disorders ha2e

pro2ided des,riptions o their pra,ti,es inind a therapist.

StressB2eryone e4perien,es stress and an4iety at one time or another. 5he dieren,e between them is that

stress is a response to a threat in a situation. An4iety is a rea,tion to the stress.

hether in good times or bad) most people say that stress intereres at least moderately with their

li2es. ;hroni, stress ,an ae,t your health) ,ausing symptoms rom heada,hes) high blood pressure)

and ,hest pain to heart palpitations) skin rashes) and loss o sleep.

1ut you ,an learn how to redu,e the impa,t o stress and manage your symptoms.

Physi,al a,ti2ityis a pro2en way to redu,e stress. egular parti,ipation in aerobi, e4er,ise has been

shown to de,rease o2erall le2els o tension) ele2ate and stabiliCe mood) and impro2e sleep and sel-esteem. Other ee,ti2e methods in,ludemind-body pra,ti,es o breathing e4er,ises) yoga) and

meditation.

ela4ation te,hniFues ha2e been used to assist in the treatment o phobias) pani, disorder) and

depression) as well as pro2iding relie or people in stressul situations. /ind out more about

,omplementary and alternati2e medi,ine.

Dearn the news and re,ent resear,h about stress.

5ry these tips when youJre eeling stressed or an4ious.

5his a,t sheet rom the National nstitute o Mental 7ealth e4plainsthe dierent types o stress) the

ee,t on your health) and how to manage it.

Related IllnessesMany people with an an4iety disorder also ha2e a ,o-o,,urring disorder or physi,al illness) whi,h ,anmake their symptoms worse and re,o2ery more dii,ult. t>s essential to be treated or both disorders.

ead on to learn more about the ,o-o,,urren,e o an4iety and these disorders:

1ipolar disorder

Bating disorders

7eada,hes

rritable bowel syndrome (1

leep disorders

ubstan,e abuse

Other related ,onditions

Bipolar DisorderMost people eel an4ious at times and ha2e their ups and downs. t is natural or a mood to ,hange or

an4iety le2el to rise when a stressul or dii,ult e2ent o,,urs.
http://www.adaa.org/netforum/findatherapisthttp://www.adaa.org/netforum/findatherapisthttp://www.adaa.org/netforum/findatherapisthttp://www.adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/stress/stress-and-anxiety-interferehttp://www.adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/stress/physical-activity-reduces-sthttp://www.adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/stress/mind-body-practiceshttp://www.adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/stress/mind-body-practiceshttp://www.adaa.org/finding-help/treatment/complementary-alternative-treatmenthttp://www.adaa.org/finding-help/treatment/complementary-alternative-treatmenthttp://www.adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/stress/news-and-research-about-strehttp://www.adaa.org/living-with-anxiety/managing-anxiety/tipshttp://www.nimh.nih.gov/health/publications/stress/fact-sheet-on-stress.shtmlhttp://www.nimh.nih.gov/health/publications/stress/fact-sheet-on-stress.shtmlhttp://www.nimh.nih.gov/health/publications/stress/fact-sheet-on-stress.shtmlhttp://www.adaa.org/understanding-anxiety/related-illnesses/bipolar-disorderhttp://www.adaa.org/understanding-anxiety/related-illnesses/eating-disordershttp://www.adaa.org/understanding-anxiety/related-illnesses/headacheshttp://www.adaa.org/understanding-anxiety/related-illnesses/irritable-bowel-syndrome-ibshttp://www.adaa.org/understanding-anxiety/related-illnesses/sleep-disordershttp://www.adaa.org/understanding-anxiety/related-illnesses/substance-abusehttp://www.adaa.org/understanding-anxiety/related-illnesses/other-related-conditionshttp://www.adaa.org/netforum/findatherapisthttp://www.adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/stress/stress-and-anxiety-interferehttp://www.adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/stress/physical-activity-reduces-sthttp://www.adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/stress/mind-body-practiceshttp://www.adaa.org/finding-help/treatment/complementary-alternative-treatmenthttp://www.adaa.org/finding-help/treatment/complementary-alternative-treatmenthttp://www.adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/stress/news-and-research-about-strehttp://www.adaa.org/living-with-anxiety/managing-anxiety/tipshttp://www.nimh.nih.gov/health/publications/stress/fact-sheet-on-stress.shtmlhttp://www.nimh.nih.gov/health/publications/stress/fact-sheet-on-stress.shtmlhttp://www.adaa.org/understanding-anxiety/related-illnesses/bipolar-disorderhttp://www.adaa.org/understanding-anxiety/related-illnesses/eating-disordershttp://www.adaa.org/understanding-anxiety/related-illnesses/headacheshttp://www.adaa.org/understanding-anxiety/related-illnesses/irritable-bowel-syndrome-ibshttp://www.adaa.org/understanding-anxiety/related-illnesses/sleep-disordershttp://www.adaa.org/understanding-anxiety/related-illnesses/substance-abusehttp://www.adaa.org/understanding-anxiety/related-illnesses/other-related-conditions


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leeping too mu,h) or ha2ing trouble sleeping

;hange in appetite or unintended weight loss or gain

5houghts o death or sui,ide) or

ui,ide attempts

t ,an be helpul to think o bipolar disorder as a spe,trum o moods.

At one end is se2ere depression) abo2e whi,h is moderate depression) and then mild low mood) whi,hmay be ,alled the blues when it is short-li2ed and dysthymia when it is ,hroni,.

Ne4t is normal or balan,ed mood) then hypomania (mild mania that may eel good and be relati2ely

brie and less se2ere) and then se2ere mania) whi,h ,an in,lude hallu,inations) delusions) or other

symptoms o psy,hosis.

ome people may e4perien,e symptoms o mania and depression together in what is ,alled a mi4ed

bipolar state. ymptoms oten in,lude agitation) trouble sleeping) signii,ant ,hange in appetite)

psy,hosis) and sui,idal thinking. A person may ha2e a 2ery sad hopeless mood e2en while eeling

e4tremely energiCed.

ead more about bipolar disorder in adultsand ind out about the illness in,hildren and teens.

Co-Occurring Anxiety Disorder and Bipolar DisorderA,,ording to Naomi M. imon) M!) Asso,iate !ire,tor o the ;enter or An4iety and 5raumati, tress

!isorders at Massa,husetts *eneral 7ospital and Assistant Proessor in psy,hiatry at 7ar2ard Medi,al

,hool) making a diagnosis o an an4iety disorder plus bipolar disorder ,an be ,onusing) and it is best

to seek help rom a mental health proessional.

1ut) !r. imon says) a ew ,lues may suggest the presen,e o both an an4iety disorder and bipolar

disorder:

5he presen,e o pani, atta,ks) signii,ant an4iety) ner2ousness) worry) or earul a2oidan,e o

a,ti2ities in addition to periods o depression and mania or hypomania.

5he de2elopment o symptoms as a ,hild or young adult) whi,h people with both disorders are

more likely to report.

ignii,ant problems with sleep and persistent an4iety e2en when not in a mani, state) andla,k o response to initial treatment.

n,reased sensiti2ity to initial side ee,ts o medi,ation) and sometimes a longer time rame

or inding the right medi,ation ,ombination and dosing.

uering rom an an4iety disorder and bipolar disorder has been asso,iated with de,reased

un,tioning and Fuality o lie and an in,reased likelihood o substan,e abuse and sui,ide attempts.

nsomnia) a ,ommon an4iety disorder symptom) is a signii,ant trigger or mani, episodes.

The Course of Bipolar DisorderEpisodes of mania and depression typically recur across the life span. Between episodes, most people with bipolar

disorder are free of symptoms, but as many as one-third find that some linger. A small percentage eperience chronic

unremitting symptoms despite treatment.

Bipolar I disorderis the classic form of the illness, which in!ol!es recurrent episodes of mania and depression.

"eople with bipolar II disorderne!er de!elop se!ere mania# instead they eperience episodes of hypomania that

alternate with depression.

$hen four or more episodes of illness occur within a twel!e-month period, a person is said to ha!e rapid-cycling

bipolar disorder. %ome people eperience multiple episodes within a single wee, or e!en within a single day. 'apid

cycling tends to de!elop later in the course of illness and is more common among women than among men.
http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml#introhttp://www.adaa.org/understanding-anxiety/related-illnesses/bipolar-disorder/bipolar-disorder-children-and-teenshttp://www.adaa.org/understanding-anxiety/related-illnesses/bipolar-disorder/bipolar-disorder-children-and-teenshttp://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml#introhttp://www.adaa.org/understanding-anxiety/related-illnesses/bipolar-disorder/bipolar-disorder-children-and-teens


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(ost people with bipolar disorder can lead healthy and producti!e li!es when the illness is properly treated. $ithout

treatment, howe!er, the disorder tends to worsen. )!er time a person may suffer more fre*uent and more se!ere

manic and depressi!e episodes than when the illness first appeared.

%ome people with bipolar disorder become suicidal. 'is for suicide appears to be greater earlier in the course of the

illness. A person with bipolar disorder, or anyone thining about committing suicide, needs immediate attention from a

mental health professional or a physician.

Treatment+o achie!e wellness, it is essential that people recei!e treatment for a co-occurring aniety disorder and bipolar

disorder. +reatment for both, howe!er, is more comple than treatment for one.

Carefully consider all treatment options with your doctor or mental health pro!ider medication, therapy, or a

combination. $ith proper treatment, aniety disorders and bipolar disorder can be o!ercome.

Medications

$hen treating a co-occurring aniety and bipolar disorder with medi,ation, most doctors first prescribe a mood

stabilier to address the bipolar disorder.

%tarting an antidepressant a common medication approach for aniety disorders/ before mood stabiliation is

achie!ed may worsen the bipolar disorder symptoms. Howe!er, an antidepressant can trigger manic episodes, e!en

while taing a mood stabilier.

0or this reason, doctors sometimes a!oid prescribing antidepressants or prescribe them at a low dose for patients

with co-occurring disorders, and they monitor carefully any patients who are taing a mood stabilier and an

antidepressant.

Because benodiaepines a class of drugs often used to treat aniety disorders/ do not appear to ha!e negati!e

effects on bipolar disorder, they may be used for aniety in patients with co-occurring bipolar disorder. Howe!er, they

may cause side effects, including physical dependence and tolerance a need for more medication o!er time/, and

there is some ris of abuse among people suffering from bipolar disorder, particularly those who ha!e eperienced

alcohol or substance abuse.

"eople may need to try a few different combinations to find the most effecti!e medications.

Types of Therapy

"eople with bipolar disorder should recei!e medication for mood stabiliation. But therapy also plays an important

role.

1sing cogniti!e-beha!ioral therapy CB+/ or another e!idence-based psychotherapy instead of medication for an

aniety disorder addresses concerns about side effects from taing mood stabiliers with anti-aniety medications.

Below are forms of therapy with !arying le!els of research e!idence for aniety disorders

;ogniti2e-1eha2ioral 5herapy. Many therapists use ,ogniti2e and beha2ior therapies) oten

reerred to as ;15) whi,h is a short-term orm o psy,hotherapy.Dearn more about ;15.

/amily 5herapy. 5his orm o therapy uses strategies to redu,e the le2el o distress within a

amily that may either ,ontribute to an ill person>s symptoms or result rom them. ela4ation 5e,hniFues. 5hese te,hniFues may help people de2elop the ability to ,ope more

ee,ti2ely with the stresses that ,ontribute to an4iety and mood) as well as with any asso,iated

physi,al symptoms. 1reathing re-training) progressi2e mus,le rela4ation) and e4er,ise are among

the te,hniFues.

nterpersonal and o,ial hythm 5herapy. Be,ti2e or bipolar disorder) this treatment

program stresses maintaining a regular s,hedule o daily a,ti2ities and stability in personal

relationships. Patients re,ord the timing o their a,ti2ities) moods) and le2els o so,ial stimulation.

As treatment progresses) they work to keep stable so,ial rhythms (when to sleep) e4er,ise) eat)
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+he age of onset for an aniety disorder often precedes the age of onset for bipolar disorder. +he co-occurrence of

an aniety disorder with bipolar disorder can worsen the symptoms and course of each disorder, so it;s essential that

both are treated.

%ometimes se!ere mood episodes, etreme irritability, and other pronounced symptoms of bipolar disorder mas

underlying obsessi!e thoughts, compulsions, worries, or other aniety symptoms. 7t;s recommended that children with

bipolar disorder are also assessed for an aniety disorder.

Helping Your ChildConsult a mental health pro!ider or physician as soon as possible if your child ehibits symptoms of an aniety or

bipolar disorder.

0ind out more information abouthelping your ,hild, including suggestions to find the right mental health

professional.5he 1alan,ed Mind /oundation websitepro!ides information about finding a therapist.

N36$ his information is not intended to provide a diagnosis or specific clinical advice to individuals

about their psychiatric condition nor to the family members or friends of individuals *ith psychiatric

conditions. Anyone seeking to rule out or establish a diagnosis or anyone seeking immediate help for a

psychiatric condition should contact a mental health professional.

Eating DisordersMost people ,an ind something they don>t like about their body) and many take steps to eat more

healthully or start an e4er,ise plan to impro2e their appearan,e.

5hose with eating disorders de2elop habits that ,an ,ause a great deal o harm. 5hey may ast or

se2erely restri,t their ,alories) e4er,ise or hours on end ea,h day) or take other a,tions to pre2ent

any weight gain. B2en though they are oten underweight) they ha2e an intense ear o be,oming at.

?sually appearing during adoles,en,e or young adul

Anxiety and Depression Disorder

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